Hipogonadizam u hroničnoj opstruktivnoj bolesti pluća (HOBP) – faktori rizika
Sažetak
Apstrakt
Uvod/Cilj. Hronična opstruktivna bolest pluća (HOBP) je vodeći uzrok morbiditeta i mortaliteta u plućnoj patologiji. Osim plućnih manifestacija, HOBP karakterišu brojni sistemski efekti, među kojima je opisan i hipogonadizam posebno u grupi muškaraca sa ovom bolešću. Cilj studije bio je procena faktora rizika za pojavu hipogonadizama kod muškaraca sa HOBP. Metode. Istraživanjem je obuhvaćeno 96 bolesnika muškog pola sa HOBP u stabilnoj fazi bolesti. Kod svih bolesnika određena je koncentracija: slobodnog testosterona u serumu, markera sistemske inflamacije, faktora nekroze tumora-alfa (TNF-α), interleukin 1-beta (IL-1β) i C-reaktivnog proteina (CRP), izvršeno je ispitivanje plućne funkcije, parametara gasne razmene, 6-minutni test hoda (6MWT), stanje uhranjenosti i stanje skeletnih mišića (midthigh muscle cross-sectional area – MTCSA), pomoću kompjuterizovane tomografije). Rezultati. Zastupljenost ispitanika sa hipogonadizmom je bila 37.5%. Ispitanici sa hipogonadizmom (slobodan testosteron < 4,5 pg/mL) su imali značajno povećanu koncentraciju TNF-α u serumu (5,88 ± 3,21 vs. 3,16 ± 2,53 pg/mL; p < 0,05), značajno manji MTSCA (68,2 ± 18,72 vs. 91,1 ± 21,4 cm2; p < 0,05) i 6MWT (268,33 ± 32,35 vs. 334,25 ± 43,25 m; p < 0,05). Nije ustanovljena statistički značajna razlika između ove dve grupe ispitanika u pogledu starosti, parametara plućne funkcije i gasne razmene, kao i indeksa telesne mase. Pomoću multivarijantne resgresione analize kao nezavisni prediktor koncentracije slobodnog testosterona izdvojila se serumska vrednost TNF-α (B= -0.157; 95% interval poverenja: -0.262–0.053). Zaključak. Analizom je ustanovljeno da TNF-α, kao sistemski marker inflamacije, predstavlja nezavisni prediktor za postojanje hipogonadizma kod bolesnika sa HOBP. Hipogonadizam je značajno povezan sa gubitkom mišićne mase i lošijim tolerisanjem napora kod ovih bolesnika.
Reference
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